17 - 20th October, Montenegro Ministry of Health Montenegro ERASMUS+ KA2 PROJECT: Enhancement of study programs in Public Health Law, Health Management, Health Economics and Health Informatics in Montenegro 17 - 20th October, Montenegro Project web site: www.ph-elim.net

DEVELOPMENT OF AN INTEGRAL HEALTH INFORMATION SYSTEM IN MONTENEGRO Ministry of Health Montenegro DEVELOPMENT OF AN INTEGRAL HEALTH INFORMATION SYSTEM IN MONTENEGRO Ministry of Health 20th October, Montenegro Marijan Marijanović Project web site: www.ph-elim.net

Project web site: www.ph-elim.net Ministry of Health Montenegro Ministry of Health is part of state administration body and carries out main administrative affairs related to health care; health insurance and provision of health care from public revenues; establishment and organization of institutions in health care and establishing conditions in terms of space, personnel and equipment of health institutions; professional development and specialization of health workers and healthcare associates; ... Ministry of Health have 10 organisation units. For IT in Health - Directorate for health economics and projects in health (monitoring and control of functioning of Integral healthcare system information system, EHR, technological and security assignments of IT infrastructure) Project web site: www.ph-elim.net

Public Health in Montenegro Public Health Institutions in Montenegro: 18 health centers 7 general hospitals 3 special hospitals Clinical Center of Montenegro Institute for Public Health 2 institutes (ZHMP and ZTK) Montenegrin Pharmacy Institute - Montefarm

Beginnings of IT in Health The development of integral health information system started in 2000. by developing the Information System of the Health Insurance Fund. Follows IS of: Montefarm (Pharmacies of Montenegro) in 2004., Private dental clinics who have a contract with the Fund in 2008., Primary health care in 2009., Secondary health care (general hospitals) in 2010 and 2011,. Emergency Medical Care (Podgorica) in 2011., Instute for public health, CALIMS (agency for drugs) in 2012., Transfusion in 2014., screening programs in 2015, Private health clinics and pharmacies who have a contract with the Fund are integrated into system by web servise and they are sending invoices

Segments of IHIS IHIS is developing as integral system. It provide support for business and medical processes in following public health institutions: Health Insurance Fund Pharmacies of Montenegro "Montefarm" Health centers General hospitals Institute for Emergency Medical Aid Blood Transfusion Institute of Montenegro Private dental clinics that have signed a contract with the Fund Private health care institutions that have signed a contract with the Fund (pharmacies and suppliers of medical-technical devices) Institute of Public Health Agency for Drugs and Medical Devices

Size of the IHIS In IHIS are connected over 2600 computers, 4930 aplicative users and required number of base, application, and reporting servers in total. In Health Insurance Fund of Montenegro is established and developed the Center of Integral Health Information System. Organizational unit of the Fund called the Sector for Development and Information Technology, together with its partners, work on maintaining, developing and improving IHIS (software and all the hardware, information and communication infrastructure, education of users). Role of Ministry of health is to, in accordance with its competencies, monitor the fulfillment of the basic principles of integration, monitoring and control of functioning of Integral healthcare information system system, EHR, technological and security assignments of IT infrastructure...

Division of business processes in IHIS In IHIS, division of process is carried on the business part that relies on finances (invoicing Fund) and the medical part that relies on the business part of which is calculated services and resources. On the basis of rendered services and spent resources, payment of services by providers of health services is made by fund, while the medical data generated on the basis on which the payment is made becomes the basis for obtaining medical data that are interest of Public health institutes for keeping records and statistic.

Business vs medical part of IHIS Business information system supports basic non-medical business processes in healthcare institutions. All of its services are interconnected and integrated with medical information system services. This system contains standard business services that are identical for all health institutions such as: personnel management, financial operations, payroll calculation, material resources management, fixed asset management, inventory and pharmacy... The medical information system contains services to support the work processes of health workers (doctors and nurses / technicians) by the level of health care and for colecting medical data for Institute of public health.

IHIS development basis Development principles of IHIS: Integrality: once the data entered in one part of system, they becomes available in any segment of the system, depending on the policy of approach Common resources: centralizing of human, hardver-comunication and software resources.

Integrality All patient informations are united in one place. They are collected from birth, regardless of which of those systems the insured - the patient appeared. Data are entered into the system only once, and then they are available throughout the system where and when they are needed. This approach allows obtaining a complete medical electronic card from all part of the system that is integrated.

Integrality Clients of all of these aplications (IS) access on-line on server infrastructure that is located in the central building of the Health insurance fund in Podgorica. All of these systems use common resources, software with shared databases (insured persons, doctors, services, diagnosis, ...) and hardware, server room is located in one place All of these information systems and Integral Health Information System as a whole, are based on three-layer WEB architecture. Center of data exchange in IHIS is located in Health insurance Fund

Not yet integrated In addition to the mentioned systems that are built with respect for the principle of integrity, there is part of the health care system is not yet included in IHIS but it will be with the plan that principle of integrity will be applied In Ministry of health is established system for collecting data about predefined resources from the system in form of Portal. Special hospitals still do not have IS, it is under construction and it will start with production by the end of the year Big part of the health care system is Clinical center of Montenegro. There are softwares that are designed to satisfy the business processes and needs of the Clinical center until this system is going to be computerized in a way that the principles of integrity are met.

Clinical center of Montenegro The first steps towards the integration of the clinical center system in IHIS were made this year by introducing a central scheduling examinations system Scheduling examinations at the Clinical Center are performed by selected doctors from health centers and with full IT support and two-way data exchange between IHIS and IS Clinical Center. In addition, the software of the clinical center exchanges part of the data from the IHIS, the base of the insured, and it is also possible to download electronic invoices and the accompanying data set according to the DRG model

New services IHIS allows informatisation of business processes, enable monitoring consumption of the system, finance, procedures - business part, allows medical professionals to view the patient's medical records, to manage statistics from medical data - medical part – all benefit system for system users From this year, entry into the system is enabled from the other way, by the end users of the system, the fund insurer. The first such service introduced by the fund this year is the system of online scheduling via the web, IOS and Android application for viewing the selected doctor's code. This system offers many options for upgrading, insight into prescribed prescriptions, electronic health records, etc. https://www.ezdravlje.me

Basics for future development Conduct continuous analysis of the system and work on enhancing integrity throughout the whole system Inclusion of remaining institutions in the IHIS with respect to the principle of integrity Introduction of new advanced services, telemedicine, electronic support for others opinion, additional services for fund insurers

Future is in eHealth eHealth aims to enable healthcare institutions, doctors and patients to benefit from ICTs, facilitate access to the latest medical information and data, contribute to the development of a timely, affordable and efficient healthcare service for all. Use of telemedicine is recognized by the Master Plan for the Development of Healthcare of Montenegro 2015-2020 for all services provided, where using modern ICT can benefit the benefits of telemedicine (unnecessary mobility of patients needed to obtain another opinion, opinion of doctors specialists, radiology, cardiology.

THANK YOU